Baby with Cold Symptoms

Dear Lisa,

I HAVE A 5 MO OLD SHE HAS RUNNY NOSE, A LITTLE COUGHING, CONGESTED CHEST, SHE JUST STARTED YESTERDAY, NO FEVER, SHE GOT ME SICK TOO. WHAT CAN I GIVE HER OR DO TO MAKE HER FEEL BETTER, CAN I TAKE COLD MEDICINE IF I AM BREASTFEEDING?

“BABY HAS A COLD”

Dear “BABY HAS A COLD”,

The treatment for an infant with an upper respiratory infection is a cool mist vaporizer. (1) The cool mist loosens nasal secretions and shrinks the swelling of the tiny nasal passages. The administration of saline nose drops also loosens nasal secretions. If your baby has a lot of thick nasal discharge, you may need to suction it out of the nostrils with a nasal aspirator or bulb syringe.

When using a nasal aspirator, first support your baby’s head and neck with one hand. Next instill one to two drops of saline into your baby’s nostril. Then deflate the bulb portion of the nasal aspirator by depressing it with your thumb. You should do this before you put the nasal aspirator into your child’s nostril. Once the bulb is deflated, then put the tip of the nasal aspirator into your baby’s nostril. Quickly remove your thumb from the bulb. The suction created will remove the nasal secretions from your baby’s nasal passages.

Since the nasal passages of a baby are sensitive, it is not a good idea to use the bulb syringe too often. The nasal aspirator should be used when you can actually see nasal secretions occluding the opening. A good time to use it is when the baby wakes in the morning, before a feeding or before bedtime. If you use the bulb syringe too often it can irritate the nasal passages.

Over the counter cough and cold preparations are not recommended for infants, especially when they are under 6 months old. (2,3,4) The reason why they are not recommended is because there is no research data that supports their effectiveness. (2,5 ) In addition, cough medications can have serious side effects in children. (2) In particular cough preparations containing codeine or dextromethorphan are not recommended in young children because of their potential to cause breathing difficulties or respiratory arrest. (2,3,4)

It is not a good idea to supress an infant's cough. A cough is a protective mechanism that protects the airway. When an infant coughs, it helps thin secretions and clear them from the airway. By masking a cough you may be falsely reassured that your baby’s condition is improving when he is not. A worsening cough is a sign that a baby needs to be evaluated by a health care professional.

Instead, it is important to monitor your daughter's symptoms. Watch for vomiting with coughing, increased frequency of coughing, rapid breathing, increased work of breathing, listlessness, fever, difficulty with feedings, retractions (the skin over the ribs suck in during breathing), grunting, pale color or irritability. These signs may represent a condition more serious than the common cold and warrant an evaluation by your baby’s Doctor or Nurse Pactitioner.

Yes, women who are breastfeeding do take medications that are necessary. Most medications taken by nursing mothers are found in some degree in breast milk. After the first couple of weeks of life, a full term infant is able to metabolize and excrete drugs. (6) These processes develop much later in infants who were born prematurely.

It is important to remember that most of the information about drugs used by nursing mothers is from anecdotal reports or stories told by those mothers who used the drug while breastfeeding. The information is not based on actual clinical research performed on nursing mothers. There are obvious reasons why this type of research has its limitations. Therefore it is important to measure the risk benefit ratio when considering taking medications while nursing.

The first step is to establish the need for a medication during breastfeeding. Certainly there are mothers with chronic medical conditions that need to take certain medications because without them their health would fail. In other situations, it is a good idea to try natural measures first and resort to medications only if they are necessary.

Some natural measures to treat cold symptoms include gargling with warm salty water, drinking extra fluids which will help loosen respiratory secretions and drinking sugar and lemon drinks which can help soothe the throat. (2) Other helpful measures include irrigating your nasal passages with saline, using steam to treat nasal congestion and sinus pressure and using lozenges and menthol cough drops to soothe an itchy sore throat and reduces cough sensitivity. (2) In addition, the heat from chicken soup and hot tea serves to soothe a sore throat and loosen nasal secretions.

If these natural remedies do not help alleviate your symptoms, an evaluation by your Doctor may be necessary. More serious conditions such as a sinus infection, throat infection or pneumonia may need to be ruled out.

Many over the counter cough and cold preparations contain ingredients that can make your baby irritable or drowsy. Another common side effect of these medications is reduction in the mother’s milk supply. (6) For this reason, these medications are avoided if possible. On the other hand, Acetaminophen (Tylenol) use in breastfeeding women is considered relatively safe. (6)

When both a mother and baby are sick, it is a good time to recruit help from other family members and freinds. Don’t hesitate to ask people for assistance because a helping hand can make a world of a difference. Getting rest can help you regain the strength that is necessary for you to get better.

I hope both you and your baby are feeling better soon.

References:
(1)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 699.
(2)Pediatric Update. Chronic Cough in Children: New Guidelines Offer New Direction. 2006. Apr:251-256.
(3)Chang AB, Glomb WB. Guidelines for evaluation chronic cough in pediatrics. ACCP evidence-based clinical practice guidelines. Chest 2006;129:260S-283S.
(4) Stephenson M. Be aware of the myriad conditions that trigger chronic cough in children. Infectious Diseases in Children. 2006. March:38.
(5)Taylor JA. Efficacy of cough suppressants in children. J Pediatr. 1993;122:799-802.
(6)Riordan J. A Practical Guide to Breastfeeding. St. Louis Missouri: The C.V. Mosby Company. 1983:138-140.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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